Provider Demographics
NPI:1003070038
Name:HAYLEY'S COMET LLC
Entity type:Organization
Organization Name:HAYLEY'S COMET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:GOMEZ
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-225-4004
Mailing Address - Street 1:1369 BLONDELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2616
Mailing Address - Country:US
Mailing Address - Phone:347-810-1700
Mailing Address - Fax:347-810-1698
Practice Address - Street 1:1369 BLONDELL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2616
Practice Address - Country:US
Practice Address - Phone:347-810-1700
Practice Address - Fax:347-810-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01527471343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)